This document provides guidance for working with LGBTQI2-S youth and young adults. It discusses the unique challenges they face, including higher rates of bullying, violence, suicide, and risky behaviors. It emphasizes the importance of acceptance and support from families and professionals. It defines key terms and recommends professionals enhance their cultural competence, promote safety and communication, and address the emotional and physical health needs of this population.

1. Working with LGBTQI2-S
Youth & Young Adults
9/2/11
Contributors
David Sanchez , Psy.D., LMFT-CA/NV, LAMFT-AZ
Rev. Elaine Groppenbacher, LCSW, MDiv
Debbie Kayatt, M.S.
Jimmie Munoz Jr.
Amy Palmisano
Kourtney Stafford
Madeline Adelman
Julie Wonsowicz-Moore, LPC
Mary Shraven
Meg Sneed
Yesmina Puckett
Yvette Jackson
Ray Lederman, D.O
Marta Grissom, MAPC
Robin Trush, M.A.
Copyedited by: Robert Hess III

2. Overview/Purpose
The purpose of this document is to provide general information to enhance
individual and organizational cultural competency when working with LGBTQI2-S
(Lesbian, Gay, Bisexual, Transgender, Questioning, Intersex, Two Spirited) youth
and young adults. Working with the population presents a unique set of issues
for consideration. Society homophobia and discrimination against sexual
orientation cause youth to be fearful. They often carry an extremely negative self
perception. LGBTQI2-S youth are likely to be victimized, bullied, threatened by
violence, witness violence and commit suicide at a significantly higher rate than
their heterosexual peers. They are also more likely to be truant from school,
engage in risky sexual behavior and abuse both drugs and alcohol.
While these
risk factors must be taken in consideration when working with this population, it is
as equally important to provide an accepting and open environment for youth.
Adults who work with LGBTQI2-S youth should examine their own attitudes
toward LGBTQI2-S relationships. As a community it is important to not only
promote tolerance, but acceptance. For these youth and young adults to have
healthy and successful life experiences, society must change attitudes and shift
perceptions and practices.
Definitions
Youth: individuals under the age of majority.
Young Adults: individuals between the ages of 18 and 25.
Gender Identity: refers to how one self-identifies. It is not necessarily based on
the person’s anatomy.
Gender Variant: a person who self-identifies as both male and female or as
neither male nor female.
Intersex (I): a person born with a set of recognized medical conditions that may
make gender difficult to determine.
Questioning (Q): a person who is questioning his/her gender identity.
Transgender (T): a person who lives or self-identifies as a member of a gender
other than that expected based on anatomical sex.
Sexual Orientation refers to an enduring pattern, or lack thereof, of a romantic,
sexual, and/or emotional attraction to men, women, or all genders. The Arizona
Department of Health has identified the following:
Bisexual (B): a person who is romantically, sexually, and/or emotionally
attracted to men, women, or all genders/gender identities.
Gay (G): a male who is romantically, sexually, and/or emotionally attracted to
persons of the same gender/gender identity.
Heterosexual: a person who is romantically, sexually, and/or emotionally
attracted to persons of the opposite gender/gender identity.
Lesbian (L): a female who is romantically, sexually, and/or emotionally attracted
to persons of the same gender/gender identity.
Questioning (Q): a person who is questioning his or her sexual orientation.

3. Two-Spirit (2-S): a term used in national publications, referencing North
American Aboriginal people that possess both the male and female spirit. This
term is not universally accepted by all Native communities.
Ally: someone who is supportive and/or advocates on behalf of the LGBTQI2-S
person.
Family: the primary care giving unit; biological, adoptive or self-created unit
residing together. Persons in this unit share bonds, culture, practices and
significant relationships.
Relationships
Family responses to a youth who identifies as LGBTQI2-S can have significant
impact on the youth’s mental health (Ryan, 2009). Acceptance promotes overall
well-being of the youth, while family rejection can increase the youth’s risk for
health problems. According to the research (Ryan, 2009) the following family
behaviors promote overall well-being of LGBTQI2-S youth:
 Talk with your child or foster child about their identity
 Express affection when learning your child’s sexual orientation or gender
identity
 Support your child’s identity, even if it makes you uncomfortable
 Advocate for your child when badly treated due to identity/orientation
 Require other family members to respect your child
 Connect your child and family to LGBTQI2-S organizations
 Connect your child to an LGBTQI2-S role model or mentor
 Welcome your child’s friends into your home
 Support your child’s gender expression
 Believe your child can have a happy future
Relationships play a critical role in the growth and development of youth and
young adults. Decreasing rejection and increasing support through safety,
education, communication and connection to supports are vital in promoting
physical and emotional well being.
 Safety: the youth must feel they can be themselves, share their feelings
and their environment need to feel comfortable. Factor which increase
safety are inclusion, respectful individuals and environments, nurturance,
acceptance and affirming one’s identity. Silence is not a sign of
acceptance. Verbal affirmation and validation of their identity is more
effective.
 Education: obtain accurate information and education on LGBTQI2-S
issues, such as terminology and health care. Become competent about

4. the types of dating relationships within the LGBTQI2-S community,
including risky sexual behaviors.
 Communication: be open to talking about identity, affirm their identity,
provide support, intervene if others are disrespectful and respect privacy
and confidentiality.
Professional Development
Adults who work with youth and young adults should take into account that in
general, up to 1 in 10 individuals will identify as being LGBTQI2-S. For this
reason, it is important to note the following suggestions for professional
development as appropriate for specific employment or volunteer roles
(Woronoff, R., Estrada, R., & Summer, S., 2006):
 Be cultural competency by learning how there are similarities and
differences with their heterosexual peers (www.glsen.org)
 Role model appropriate behavior
 Learn youth and young adult emotional and medical issues
 Teach youth and young adults life skills unique to their needs
 Learn how to deal with trauma the youth and young adults may have
experienced such as bullying, victimization, sexual abuse, physical abuse
 Teach and support the youth with “coming out” skills
 Learn how to react, process and respond when a youth or young adult
“comes out”
 Teach the youth and young adults how to plan ahead for future “failure” in
relationships and personal goals
 Know community resources for referrals for staff and families or caregivers
 Learn how to normalize LGBTQI2-S dating and relationship issues
 Learn basic sex education for LGBTQI2-S
 Be flexible and patient in responding to needs or changes in their needs
 Learn how to identify LGBTQI2-S affirming adults and allies as needed
supports
 Learn how to engage prospective foster parents in discussions in order to
gauge their views on sexual orientation and gender identity
 Work with local LGBTQI2-S community centers and organizations to
develop comprehensive outreach and recruitment strategies.
Health: Emotional and Physical
Organized approach to addressing health disparities must take into account the
LGBTQI2-S population. Specifically, when working with the LGBTQI2-S
population health care must address three prominent issues; the prevention of
health conditions that are prevalent in the population; the adequacy of delivered
health care; and the reduction of barriers that disrupt resiliency.

5. Prevention:
 Ensure that practitioners providing healthcare for LGBTQI2-S youth
understand and are sensitive and responsive to the emotional distress
commonly experienced by their patients and make appropriate referrals to
behavioral healthcare providers.
 Incorporate LGBTQI2-S elements into mandatory Cultural Competency
Training.
 Reduce the hetero-centric bias in medical and public health education and
practice that often leads to disparities in providers’ knowledge of
transgender and intersex anatomy and the health disparities affecting
youth that diminish the likelihood of LGBTQI2-S patients receiving
appropriate screenings and preventive care.
 Ensure that practitioners respect and support gender identity and
expression.
 Ensure that health care providers are knowledgeable about the precursors
and causes of prevalent health care concerns and are both competent and
comfortable providing prevention counseling.
 Ensure that health care providers are educated on the unique health care
needs and are both comfortable and experienced addressing safe sex
practices, sexual hygiene, sexually transmitted diseases, substance
abuse, the management of HIV and AIDS, and providing appropriate
health care and disease prevention education.
 Promote effective and appropriate means of addressing “closeted”
LGBTQI2-S individuals.
Treatment:
 Increase research and the development of more quantitative and
qualitative information on health disparities for LGBTQI2-S individuals, as
well as healthcare access and utilization patterns.
 Provide transgender and nonconforming gendered youth with access to
health care providers who are knowledge about their emotional and health
care needs and ensure these youth receive recommended medically
necessary treatment including trans-gendered related care.
 Ensure that behavioral healthcare providers have specialized training in
the screening, assessment, diagnosis, and treatment of gender identity
disorders and expertise in adolescent development, and do not try to
change a youth’s gender or identity as a part of treatment.
 Revise forms for services such that they are written to be gender inclusive
(see definitions) and relationship inclusive.
Resiliency:
 Enhance formal efforts to reduce the stigmatization that prevents many
youth from identifying themselves as lesbian, gay, bisexual, or
transgender.

6.  Ensure that practitioners foster a climate of respect for within the medical
community.
 Ensure that practitioners providing healthcare understand and are
sensitive and responsive to the emotional distress commonly experienced
by their patients and make appropriate referrals to healthcare providers.
 Provide available resources to address the family confusion,
misunderstandings, biases and rejection that foster unnecessary trauma,
health care disparities, homelessness and poor emotional and health
outcomes.
 Ensure that practitioners providing health care for are knowledgeable
about supportive services available from local and national resources and
assist youth in receiving them.
Services and Supports
Providing services and supports to the LGBTQI2-S community should be
considered by various professionals including: education, health care,
recreational and employment entities. Strategies include (Hammer, C., &
Woodward C.M., 2005):
 Organizations and businesses may display a visible non-discrimination
statement in their lobby and/or on their marketing materials.
 A welcoming smile and positive greeting may set the tone for a visitor’s
experience and or interaction. Staff attitudes toward difference may
impact a visitor’s/individual’s perceptions related toward “outness” and
safety.
 Create an atmosphere of safety and inclusiveness by hanging
posters/photos indicating acceptance of LGBTQI2-S people/relationships
and acceptance for diversity.
 Encourage openness to talk about LGBTQI2-S issues.
 Use gender neutral language (partners, significant other) in relationships
 Become an Ally.
Information about becoming an Ally can be found in The Safe Space Kit: Guide
to Being an Ally to LGBT Students written by the Gay, Lesbian, and Straight
Education Network (GLSEN) (2009). This publication recommends for Allies to
familiarize themselves with LGBTQI2-S issues, to be supportive, to educate self
and others on the LGBTQI2-S community, and to advocate for acceptance of
LGBTQI2-S people. Examples noted are:
 Respond to anti-LGBTQI2-S behavior.
 Be a role model of acceptance.
 Support LGBTQI2-S community events.
 Teach respect and tolerance.
 Advocate for the promotion of non-discriminatory practices and
policies.

7. Additional information can also be found at: www.lgbtconsortium.com
Elementary and Secondary Education Institutions
Educational settings can be a place where homophobia exists amongst students
and administrators. Creating a healthy and safe environment is essential to
educational achievement. The Gay, Lesbian, Straight Education Network
(GLSEN) (2009) offers the following suggestions:
Ten Things Educators Can Do to Ensure Respect for All is Taught in Schools
1. Do not Assume Heterosexuality
2. Guarantee Equality
3. Create a Safe Environment
4. Diversify Library and Media Holdings
5. Provide Training for Faculty and Staff
6. Provide Appropriate Health Care and Education
7. Be a Role Model
8. Provide Support to Students
9. Reassess the Curriculum
10. Broaden Entertainment and Extra Curricula Programs
Additional resource material can be found at:
 National School Climate Survey : http://www.glsen.org/binary-
data/GLSEN_ATTACHMENTS/file/000/001/1801-1.pdf
 Middle School Climate Report:http://www.glsen.org/binary-
data/GLSEN_ATTACHMENTS/file/000/001/1475-1.pdf
 http://www.glsen.org/cgi-bin/iowa/all/news/record/2619.html
Spirituality
Robert Coles (Coles, 1990) wrote that a child has a "spiritual life that grows,
changes, responds constantly to other lives that, in their sum, make up the
individual we call by a name and know by a story that is all his, all hers”.
Adolescents and young adults build on this spiritual life when they face the
developmental task of critically examining and questioning prior beliefs in order to
embrace, whether religious or secular, their own spiritual principles or beliefs.
These beliefs to help them understand who they are as individuals, how they fit in
the universe, and what it take to be meaningfully connected to others and the
world.
Just as sexuality or gender identity is core to a person’s sense of self, spirituality
is a most personal expression of one’s identity. Yet for many LGBTQI2-S youth
and young adults, this arena of life brings them face to face with value judgments
of others and rejection by family, friends and communities of faith. A full spectrum

8. of emotions accompanies this loss of connection, which often overshadows how
spirituality can serve as an anchor and compass for living. Research indicates
that for all the perceived damage spirituality as associated with organized religion
brings, spiritual practice is linked with a positive sense of well being amongst
LGBTQI2-S individuals (Wilson, 2004). So, how do we support our youth and
young adults to discover and explore their unique spiritualities?
To support youth and young adults in this area, we need to:
• Shelve all assumptions, especially any notion that young people reject
spirituality as a whole. In reality, young people have interest “sometimes
deeply so – in spiritual issues, though their preferred spiritual expression
varies” (Wilson, 2004).
• Have clear sense of our own spiritual and religious perspectives and
embrace the need to address spirituality even with youth.
• Build up our own general knowledge about faith traditions in the world, but
encourage the youth and/or young adult to provide their specific beliefs.
• Be non-judgmental.
• Help youth and young adults develop solid, caring, and affirming
relationships that can help them develop spiritually and discover the
connection between spirituality and daily living, healthy relationships, and
problem solving (Nix-Early, 2004).
• Build a network of spiritually mature adults, consultants, and faith tradition
leaders who have demonstrated a credible track record embracing and
working with LGBTQI2-S youth.
• Encourage and intentionally support youth in developing their individual
expressions of spirituality, own faith/spirituality celebrations and rituals,
and practices.
• And finally, “restore compassion back to the center of morality and
religion, … encourage a positive appreciation of cultural and religious
diversity” (Armstrong, 2009) and “listen for understanding rather than for
agreement or disagreement” (Barnes, et al, 2000).
Involvement in the Juvenile Justice Systems
There are still many myths regarding sexual orientation and gender identity are
labeled as a sexual deviant and/or with mental illness even though medical and
mental health professions have roundly rejected. “These biases can cloud
decisions related to arrest, charging, adjudication, and disposition, with the
cumulative effect of punishing or criminalizing LGBT(IQ2-S) adolescent sexuality
and gender identity.” There are several contributing factors that increase the
likelihood of justice contact for LGBTQI2-S youth which including the following
(Maid, Marksamer & Reyes, 2009):
 Pervasive issues at school due to harassment and truancy

9.  Homelessness and runaway status; youth are often kicked out or flee
domestic abuse by family members unable to accept the youth’s gender
identity or sexual orientation
 Involvement in survival crimes such as theft and prostitution
 High rates of underage drinking and substance abuse
Once LGBTQI2-S youth are entered into the juvenile justice there are highly
vulnerable to the system which can include the following:
 Court and law enforcement officials’ lack of understanding about sexual
orientation and gender identity issues
 Verbal, physical, and sexual abuse by staff and fellow residents in court-
ordered placements
 Unnecessary use of isolation and segregation in confinement
 Inappropriate sexual offense charges arising from consensual same-sex
conduct
Although there are barriers that currently exist, enhancing the ability of juvenile
justice professionals to ensure fair and effective decision making is achievable.
The recommendations below are designed to ensure due process protections
and improve outcomes for LGBTQI2-S youth. They are intended to be related to
the scope of work for all juvenile justice professionals including but not limited to;
judges, defense attorneys, prosecutors, probation officers, and detention staff
 Juvenile justice professionals must receive training and resources
regarding the unique societal, familial, and developmental challenges
confronting LGBTQI2-S youth and the relevance of these issues to court
proceedings. Trainings must be designed to address the specific
professional responsibilities of the professional.
 All Juvenile justice professionals must treat and ensure that others treat all
youth with fairness, dignity, and respect, including prohibiting any attempts
to ridicule or change a youth’s sexual orientation or gender identity.
 Juvenile justice professionals must promote the well-being of transgender
youth by allowing them to express their gender identity through choice of
clothing, name, hairstyle, and other means of expression and by ensuring
that they have access to appropriate medical care if necessary.
 Juvenile justice professionals must develop individualized,
developmentally appropriate responses to the behavior of each youth,
tailored to address the specific circumstances of his or her life.
 All agencies and offices involved in the juvenile justice system must
develop, adopt, and enforce policies that explicitly prohibit discrimination
and mistreatment of youth on the basis of actual or perceived sexual
orientation and gender identity at all stages of the juvenile justice process.
 Juvenile courts must collaborate with other system partners and decision
makers to develop and maintain a continuum of programs, services, and
placements competent to serve LGBTQI2-S youth, including prevention

10. programs, detention alternatives, and non-secure and secure out-of-home
placements and facilities. Programs should be available to address the
conflict that some families face over the sexual orientation or gender
identity of their child.
 Juvenile justice professionals and related stakeholders must ensure
adequate development, oversight, and monitoring of programs, services,
and placements that are competent to serve LGBTQI2-S youth.
 Juvenile justice professionals must adhere to all confidentiality and privacy
protections afforded youth. These protections must prohibit disclosure of
information about a youth’s sexual orientation and gender identity to third
parties, including the youth’s parent or guardian, without first obtaining the
youth’s consent.
Youth in Out-of-Home Placement
For purpose of defining out-of-home placement, this would include situations
where youth have been placed in the foster care system and/or within
congregate care. When residing in a placement away from one’s family of origin
or community, several considerations should be addressed for youth and young
adults (National Recommended Beast Practices…, 2009):
 Community resources for referrals for youth
 Community resources for families or caregivers
 Normalcy and Respect
 Accessibility to diversity and diverse events with straight Allies
 Groups with youth and young adults that are LGBTQI2-S specific
 A safe space where they know it is okay to try, practice and fail personally
 Socialization skills training
 Training on dating and appropriateness in public spaces
 Basic sex education for LGBTQI2-S
 Individual and Family Counseling with biological and/or family members
 Help developing ties in the community as well as mentors
 Additional transitional planning
 Ensure that staff never automatically isolate or segregate LGBTQI2-S
youth from other participants for the LGBTQI2-S youths’ protection.
 Inform LGBTQI2-S youth participants of the different types of sleeping
arrangements available, including beds close to direct care staff if the
youth participant prefers to be in eyeshot/earshot of staff.
 Ensure that transgender or gender-nonconforming youth participants are
not automatically placed based on their assigned sex at birth, but rather in
accordance with an individualized assessment that takes into account
their safety and gender identity.
 Ensure that individual LGBTQI2-S youth participants are not placed in a
room with another youth who is overly hostile toward or demanding of
LGBTQI2-S individuals.

11.  Allow transgender youth to use bathrooms, locker rooms, showers, and
dressing areas that keep these youth physically and emotionally safe and
provide sufficient privacy
 Allow youth to express their sexual orientation through their choice of
clothing, jewelry or hairstyle. (Wilber, 2009)
 Provide youth with access to LGBTQI2-S inclusive, supportive books and
materials. (Wilber, 2009)
 Youth should be allowed to post LGBTQI2-S-friendly posters or stickers in
their room. (Wilber, 2009)
 Ensure that staff do not prohibit LGBTQI2-S youth participants from
having roommates or isolate these youth from other youth
 Maintain regular contact with youth participants placed in scattered-site
housing units (apartments in the community) to protect them from
emotional isolation and ensure they are free from harassment and
discrimination.
 Create a safety plan for youth placed in scattered-site housing to respond
to verbal harassment, physical threats to safety, and sexual exploitation by
neighbors and community members.
Youth in Foster Care settings (Wilber, S., Ryan, C., Maksamer, J., 2009):
 Assistance with the process of coming out and learning the levels of
acceptance by others Foster families to examine their own beliefs and
attitudes and ensure their ability to professionally and ethically serve
LGBTQI2-S youth.
 All foster parents who make a permanent commitment to LGBTQI2-S
youth to be provided with accurate, evidence-based information about
LGBTQI2-S youth, including the effects of social stigma on adolescent
development.
 Foster families to be trained to understand the challenges they may
confront as they adjust to the support they and their LGBTQI2-S child will
need at home and in the world.
Youth in Transition and Young Adults
All young adults experience life changing events as they reach the age of
majority. For LGBTQI2-S young adults, these can be magnified by existing
challenges faced in youth. Previous experiences are the foundation for the
transition to independence. These individuals may have existing issues
surrounding family rejection, depression, substance abuse and the inability to
access services and/or supports to succeed during this time of their life. The
Transition to Independence (TIP) System developed by Hewitt B. “Rusty” Clark
(2007) is a practice model designed for working with youth who have
experienced emotional challenges. The basic components of this model can be
applicable to considerations when working with transition-age LGBTQ2-S youth.
The TIP System Guidelines include the following:

12.  Engage young people in relationship development and focus on their
future
 Services/supports should be accessible, non-stigmatizing and
developmentally appropriate – building on strengths to enable them to
pursue their goal
 Acknowledge and develop personal choice and social responsibility
 Develop a safety-net of support by involving family, friends and key
players
 Enhance young persons’ competencies to assist them in achieving greater
self-sufficiency and confidence
During this time in a young person’s life, basic daily needs such as housing, food,
health care, education and/or employment, transportation and monetary support
often become their sole responsibility. In addition, peer norms for alcohol
consumption at the legal at the age of 21 and increased access to illegal drugs in
the bars, raise additional societal pressures to a young person who may already
be having some emotional challenges. The TIP model is the only evidence-
supported practice shown to be effective in achieving outcomes for youth who
face these life barriers.
References
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http://charterforcompassion.org
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(October).
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